Annette C and Harold C Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA.
Liver Transpl. 2012 Apr;18(4):455-60. doi: 10.1002/lt.22474.
Whether a positive crossmatch result has any relevance to liver transplantation (LT) outcomes remains controversial. We assessed the impact of a positive crossmatch result on patient and graft survival and posttransplant complications. During a 20-year period, 2723 LT procedures with crossmatch results were identified: 2479 primary transplants and 244 retransplants. The rates of positive B cell and T cell crossmatches were 10.1% and 7.4%, respectively, for primary transplants and 14.6% and 6.4%, respectively, for retransplants (P = 0.049 for a B cell crossmatch). Across all primary transplants, females (P < 0.001) and patients with autoimmune hepatitis (P < 0.001) had greater frequencies of positive crossmatches. There was no effect from race or age. For both primary transplants and retransplants, patient survival and graft survival were not affected by the presence of a positive crossmatch. With respect to posttransplant complications, there were no differences in rejection episodes (hyperacute, acute, or chronic) or technical complications (biliary and vascular) between negative and positive crossmatch groups. However, there were significant differences in the pathological findings of preservation injury (PI) on liver biopsy samples taken at the time of transplantation and within the first week of transplantation (P = 0.003 for B cells and P = 0.03 for T cells). In summary, a positive crossmatch had no significant impact on patient survival or graft outcomes. However, there was a significantly higher incidence of PI in primary LT recipients with a positive crossmatch. This finding is important for a broader understanding of PI, which may include a significant immunological component.
供者与受者间交叉配合试验阳性结果对肝移植结局的影响仍存在争议。我们评估了交叉配合试验阳性结果对患者和移植物存活率及移植后并发症的影响。在 20 年期间，我们确定了 2723 例具有交叉配合试验结果的肝移植手术：2479 例初次移植和 244 例再次移植。初次移植的 B 细胞和 T 细胞交叉配合试验阳性率分别为 10.1%和 7.4%，再次移植的分别为 14.6%和 6.4%（B 细胞交叉配合试验阳性率比较，P=0.049）。在所有初次移植中，女性（P＜0.001）和自身免疫性肝炎患者（P＜0.001）的交叉配合试验阳性率更高。种族或年龄对此无影响。对于初次移植和再次移植，阳性交叉配合试验对患者存活率和移植物存活率均无影响。关于移植后并发症，阴性和阳性交叉配合组之间在排斥反应（超急性、急性或慢性）或技术并发症（胆道和血管）方面无差异。然而，在移植时和移植后第一周肝活检样本的保存损伤（PI）的病理发现方面存在显著差异（B 细胞为 P=0.003，T 细胞为 P=0.03）。总之，阳性交叉配合试验对患者存活率或移植物结局无显著影响。然而，阳性交叉配合的初次肝移植受者的 PI 发生率显著更高。这一发现对于更广泛地了解 PI 很重要，PI 可能包括重要的免疫成分。
